01 / Agents

Four task-built agents.
One claims workflow.

Each agent owns a single, high volume job from the moment it starts to the moment it is written back to the claim. That narrowness is deliberate: an agent with one job can be measured, corrected and trusted in a way a general assistant cannot.

Agents can be run one at a time. Most teams start with whichever queue is loudest, usually inbound status or intake, and add the others once the first is carrying real volume.

All four read and write the same claim context, so an answer given on the phone matches what the file says five minutes later.

Agent 01

Files every new loss.

First notice of loss by phone, email or upload, filed without manual data entry.

A first notice of loss arrives in whatever shape the person reporting it had to hand: a call from a supervisor at the end of a shift, an email with a photographed form attached, a broker's PDF, a voicemail left after hours. The intake agent takes all of them, in the channel they arrive on.

It reads or listens, extracts the fields your schema requires, checks them against the policy and the parties already on record, and chases what is missing before the report is closed out. When the reporter is still on the phone, it asks in the moment, which is the only time that question is cheap to answer. When the report came by email, the follow-up goes back by email, in a thread the next person can read.

What reaches your team is not a task to key in. It is a filed claim: policy matched, parties identified, loss described in your own fields, with the original recording or document attached to it.

Arrives as
Inbound call, voicemail, email with or without attachments, scanned paper, portal or broker upload, or a structured payload over the API.
What it captures
Reporter and their relationship to the loss, claimant details, policy or coverage reference, date, time and place of loss, mechanism and narrative, injury or damage detail, employer or insured, and treating provider where it is already known.
What it checks
Policy match, duplicate against open claims, jurisdiction, required-field completeness for the line of business, and its own confidence in anything it transcribed from audio or a scan.
What it writes back
A filed claim in the system of record with structured fields populated, the source attached, and a note stating what was captured, what was confirmed with the reporter and what remains open.
Where it stops
A required field it cannot establish, a policy it cannot match with confidence, or any indicator your team has flagged for a person, such as a fatality or a report that reads as catastrophic.

Why it matters. Intake quality sets the ceiling on everything downstream. A claim that arrives complete can be triaged, reserved and assigned the same day. A claim that arrives as a half legible form becomes three follow-up calls that nobody has time to make.

Agent 02

Answers the status call.

Inbound status, picked up in real time, with the whole claim in context.

A claimant wants to know whether the check has gone out. An employer wants to know what is being paid and until when. A provider wants to know whether a treatment was authorized. These calls are short, they are predictable, and in most claims shops they are the largest single source of inbound volume.

The status agent answers them. It verifies the caller against the record, reads the current state of the claim, and explains it in plain language: what has been paid, what is pending, what has been requested from whom, and what happens next. There is no hold while someone opens the file, because the file is already open.

It knows the limits of its brief. It reports what the record says. It does not interpret coverage, it does not argue a denial, and it does not improvise a date that nothing in the file supports. When a caller asks for any of those, it says so and routes the call to the person who owns the claim, with a summary of what was already asked.

Who it answers
Claimants, injured workers, employers, policyholders, treating providers, attorneys' offices and brokers, each verified against the parties on the claim before anything is disclosed.
What it can say
Claim status, what has been received, what is outstanding, payment and authorization status as recorded, scheduled appointments and examinations, next expected step and who holds it.
What it will not say
Anything the record does not support, anything the caller is not entitled to hear, and any judgment on coverage, compensability, liability or settlement.
What it writes back
A note on the claim identifying the caller, what was asked, what was told, and any new information the caller volunteered, such as a change of address, a return to work date or a new provider.
Escalates when
The caller disputes a decision, raises a complaint or a regulatory matter, asks for something outside the brief, or asks for a person. The handoff carries the context so nobody has to start again.
Languages
The voice agents operate in more than one language, with the same claim context and the same limits in each.

Agent 03

Makes the calls no one gets to.

Outbound contact to employers, providers and injured parties, with every outcome logged.

Outbound is the work that quietly does not happen. Wage statements, records requests, authorization follow-ups and welfare checks all sit on a worklist with no deadline attached, and a claim ages while they wait. The outreach agent works that list.

It calls employers for wage and return to work information, providers for records and appointment availability, and injured parties for the detail a claim needs to move. It leaves messages when nobody answers, tries again on a cadence your team sets, and stops when it has what it was sent for.

Every attempt is written to the file: who was reached, when, what was said, what was promised and what arrived. The result is a chase log that reflects reality rather than a reminder that somebody meant to call.

Who it reaches
Employers and their payroll contacts, treating physicians and their offices, imaging and therapy providers, injured parties and claimants, and any other party on the claim your team nominates.
What it asks for
Wage statements, work status and restrictions, return to work dates, medical records and reports, appointment and examination availability, authorization confirmations, and missing signatures or forms.
How it follows up
On a cadence you define per task and per party, with attempt limits, quiet hours, voicemail rules and a defined point at which it hands the task to a person rather than calling again.
What it writes back
Every attempt and outcome as a note on the claim, with any document received attached and indexed, and the task closed only when the thing it was sent for actually arrives.
Escalates when
A party refuses, a contact is wrong, attempt limits are reached, or the call turns into something other than the request, such as a dispute or a report of a new injury.

Agent 04

Sits beside the adjuster.

Retrieves, cites, analyzes and recommends. The decision stays with your team.

By the time a claim is contested, the file holds hundreds of pages written by people who never expected them to be read together: records, correspondence, forms, invoices, notes. The answer to most questions about that claim is already somewhere in there. Finding it is a research task performed under time pressure.

The assistant does the research. Ask it what is outstanding, whether the mechanism of injury is consistent across the file, what a provider actually said in a report, or what has changed since the last review, and it pulls the relevant passages and answers from them, with a reference to every document and note it used.

It will also tell you what it could not find. An answer the file does not support is not an answer we are willing to generate, and a recommendation is only ever a recommendation: the adjuster reads the source, makes the call, and owns it.

What you can ask
What is outstanding, what changed since a date, whether the account of the loss is consistent, what a specific report or note says, how the medical timeline runs, and what the next action should be.
How it answers
From the documents and notes on that claim, with a citation to each source it used, so the adjuster can open the page rather than take the summary on trust.
What it surfaces
Gaps, contradictions between sources, missing authorizations and signatures, overdue requests, and anything in the file that has not been actioned.
What it recommends
A concrete next action with the reasoning attached, for example requesting a specific record, scheduling an examination or contacting a named party.
What it will not do
Decide compensability, set or change a reserve, approve or deny a payment, or state anything as fact that the file does not support.

Four agents, one version of the truth.

The agents are not four tools that happen to share a logo. They read and write the same claim context, which is the only reason the system holds together in practice.

When outreach receives a wage statement at nine, the status agent is answering from it at ten and the assistant is citing it at eleven. A caller is never told something the file contradicts, because there is only one file and every agent is reading it.

Operating rules

What every agent does the same way.

The behaviour below is not configurable per agent. It is how the system works.

01

It identifies itself

On a call or in an email, an agent says what it is at the start of the interaction. Nobody is led to believe they are speaking with your adjuster, and your organization is named as the party on whose behalf it is calling.

02

It works inside your permissions

An agent reaches exactly the systems and records your access model grants it, under credentials you issue and can revoke. It does not hold a separate copy of your book, and it cannot see a claim your controls would not show the person who configured it.

03

It writes everything down

Every call, message, document read and field written is logged against the claim with the agent, the action and the time identified. There is no agent activity that exists only inside our system and not inside yours.

04

It knows where it stops

Each agent has an explicit boundary and an explicit escalation path, defined with your team before it goes live. When it reaches that boundary it hands over with context attached, rather than improvising past it.

Questions

What claims leaders ask us first.

Does an agent ever decide a claim?

No. Compensability, reserves, coverage positions, settlement authority and anything else that requires a licensed and accountable human being stays with your team. The agents capture, communicate, retrieve and recommend. They do not decide, and we have no plans to let them.

What happens when an agent gets something wrong?

Two things. The interaction is on the record, with the source it worked from, so the error is visible rather than buried. And the boundary that let it through is adjustable: thresholds, escalation triggers and the phrasing an agent is permitted to use are configuration, not a model we ask you to accept as given.

For anything a caller is told, the agent works from the recorded state of the claim. If the claim is wrong, the answer will be wrong in the same way a person reading the same screen would be, which is why write-back accuracy at intake matters as much as the conversation itself.

Do callers know they are talking to an agent?

Yes. Disclosure happens at the start of the interaction, in the language the call is being handled in. A caller who asks for a person gets one.

Can we run one agent without the rest?

Yes, and most teams do at first. Each agent is independently useful, and the usual starting point is whichever queue your team complains about most. The shared context becomes an advantage as the second and third agent come online, not a prerequisite for the first.

How much configuration does this need from us?

The substantive work is agreeing three things: how your fields map to what an agent captures, what an agent is allowed to say or ask on your behalf, and where it must stop and escalate. That is a working session with the people who run the queue, not a procurement exercise.

The technical side is system access and a connection method, which is covered on the integrations page.

Next step

Put an agent on the work your team dreads.

Tell us which queue is loudest and we will tell you straight whether an agent belongs on it.

Get in touch